The clinical benefits of reconstructing the medial column support in locked plating of proximal humerus fractures

Abstract

Objective To evaluate the clinical benefits of reconstructing the medial column support in locked plating of proximal humerus fractures.Methods A retrospective analysis was conducted of the eligible 125 patients who had undergone locked plating of proximal humerus fracture in our institution between June 2005 and December 2010.They were 54 men and 71 women,18 to 88 years of age (average,54.6 years).By the Neer classification,there were 57 cases of two-part fracture,62 cases of three-part fracture and 6 cases of four-part fracture.One independent examiner evaluated their postoperative radiographs of the shoulder to divide the patients into a group of adequate medial column reconstruction (84 cases) and a group of inadequate medial column reconstruction (41 cases).The postoperative Constant scores of the shoulderfunction,humeral inversion angles,visual analog scale (VAS) pain scores and complications were compared between the 2 groups.Results All the patients obtained a mean follow-up of 13.6 months (range,from 6 to 30 months).The clinical outcomes in the group of adequate medial column reconstruction were all significantly better than those in the group of inadequate medial column reconstruction in terms of mean Constant shoulder score (77.9 ± 13.0 vs.67.3 ± 11.3),excellent to good rate (72.6％ vs.43.9％ ),VAS pain score (1.6 + 2.0 vs.3.2 ± 2.4),humeral inversion angle (1.2°± 3.3° vs.4.4°± 4.0°),complications rate (16.6％vs.34.1％) and secondary operation rate (4.8％ vs.17.0％) (P ＜0.05).Conclusion In the locked plating of proximal humerus fractures,reconstruction of the medial column support has benefits of enhanced mechanical stability of the humeral head,reduced secondary neck-shaft angle loss and fewer implant failure to ensure good chnical outcomes. Key words: Shoulder fractures; Bone plates; Fracture fixation, internal